NPI | 1376690750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00606300) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009084) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2020-09-08 |